Despite the virtual ubiquity of CAT and MRI scans, the electroencephalograph or EEG is still the most frequently used neurodiagnostic tool today. It is famously accurate in diagnosis of seizure disorders, but has also played a major supporting role in the detection of drug abuse, brain damage, and the monitoring of long-term decline in mental and motor abilities. The EEG measures the relative levels of activity of a number of Greek-named (alpha, beta, gamma, theta, etc.) designated frequency brain waves. Disordered or out of balance readings generally indicate different diseases depending on their patterns.
To some degree, you can imagine the EEG as a thermometer. It tells you something about your body, but you don’t expect that your body could tell the thermometer anything back.
We have known since the 1970s, however, that certain people can indeed, “talk back to their EEG.” In a study of EEGs begun for other reasons entirely, a student volunteer at the University of Chicago lab of Professor Joe Kamiya, could, at the sound of a bell, state exactly which Greek letter brain wave state he was in. Given that the test was for detecting alpha waves, one could argue that a “yes or no” answer was a 50:50 probability situation. But the kid did it correctly up to 400 times straight. The student could not explain how he was able to perform this feat. He just did it, and even got better at it, not knowing how he did that either. Clearly Kamiya had stumbled onto something extraordinary.
In the meanwhile, the EEG had expanded into a number of newer diagnostic areas, for illnesses that seem to have a burgeoning number of new victims, where speedier diagnoses were needed in the place of costly and sometime ambiguously definitive, multiple visits of a patient to an educational or mental health therapist. It was soon found, for example, that growing numbers of young persons, and even adults, diagnosed with ADHD had predictably abnormal EEG patterns. A debate began in the neurological community, which has still not been fully resolved, as to whether it was the abnormal brain waves that caused the ADHD or whether these were simply a common co-occurrence that did not signal causality, just a correlation.
Fast forward to today, and you will find several hundred to a thousand neurofeedback therapists treating ADHD, usually as part of a conventional practice in psychology, clinical social work, or private after-school remedial teachers or school counselors. They will have begun their assessment of the patient by taking some very standard EEG measurements and charting them as a baseline. Then the therapist hooks up the patient (who is still painlessly wearing his EEG electrodes,) to two computers with large screens. The patient faces one screen, showing, perhaps a video of some imaginary landscape over which the patient is flying, or of a colorful fractal pattern unfolding. The patient, stares at the screen, and, perhaps to his or her amazement, the action speeds up, slows, or halts. Eventually, the patient realizes, that through a kind of unconscious brain wave focusing process that the patient does not understand, he or she is actually in control of the speed.
In reality, the therapist, looking at a second screen that monitors the EEG brainwaves, programs the video to advance faster as certain brain waves are optimized, while others are reduced, or when some formulaic interrelation among the Greek numbers is approached. The therapist keeps a running EEG log during each session and with practice from week to week, the patient is able to fly though the video like a jet instead of a glider, and the fractal pattern unfolds at sometimes blinding speeds.
The therapist can actually increase the precision level required for the patient to change the speed of video movement, and, without the patient knowing how he or she does it, the patient will again, adjust his brain waves with just enough precision so as to regain the speed he or she had previously attained.
What the patients do not realize is that, week after week, they are progressively self-regulating their EEG waves back to a normal pattern, that usually stabilizes after the course of 20-50 visits, depending on the patient, with the few relapses managed with a few booster sessions.
Concurrently, the patients, or their parents and teachers, report that the patient is feeling better, can concentrate at a highly improved level, and in some cases, also feels less anxious, angry or depressed. Grades go up. Adverse conduct reports go down.
Now here comes the rub: Some neurofeedback therapists advise patients or their parents that they can then discontinue their Ritalin or other prescribed drugs, contrary to the longstanding medically-sanctioned multimodal treatment plan of drugs, counseling and compensatory classroom accommodations.
Not surprisingly, this has incurred the wrath of the MD neurological community, and also of some Ph.D.s in Clinical Psychology, who do research or cooperate with MDs in ADHD treatment. They point out the following:
· The number one reason that people stop treatment with drugs like Ritalin are perceived long-range ill-effects or fears of some sort of dependency or addiction, which in fact, occur in a tiny percentage of patients, if at all. The consensus opinion of the medical and pharmaceutical profession is that while these drugs are not always effective for everyone, they are safe and effective for over 90%, although the degree of control or improvement seems to be a moving target, depending on the study, and the criteria used.
· In any case, most neurofeedback therapists have no medical training which would allow them to speak about drug trials or treatments with any kind of authority (47% of the membership of the leading the leading NFT professional group, the International Society for Neurofeedback and Research hold Ph.D.s, and 26% hold master’s degrees in social work, mental health, or educational counseling. A few percent are MDs).
· Most published studies of neurofeedback are flawed in that they are rarely double blind, have too few participants, and do not control well enough for various confounding factors that would make their claims of efficacy air-tight. Basically, the critics of NFT say that the proof that NFT is bunk is that it cannot get NIH approval for a large-scale clinical trial. (NFT replies that this is because psychopharmacologically-inclined neurologists are assigned to be the evaluators that get to approve or deny these proposals.)
· Proponents claim improbably that NFT can improve dozens of conditions. Apart from ADHD there are studies published by NFT practitioners claiming efficacy for addictions, anxiety, asthma, autism, autoimmune disorders, (and that was just the letter As….) This sounds too much like medical device quackery rather than serious therapy.
· Much of the literature supportive of NFT is published in book-length paperbacks by alternative presses one has never heard of, unless one is into talking with ghosts, astrology, or the legalization of marijuana, and the like. Such literature avoids a balanced discussion of pro-and-con scientific evidence in truly scholarly research and professional journals, and instead, talks about government, medical, or drug company “conspiracies to silence this revolutionary therapy,” and it must be said that the proponents of NFT are more likely to appear on “Oprah,” than at a serious medical conference.
Without this author taking any side in this debate on the clinical efficacy of NFT for given conditions, this last criticism of suspect publication patterns made by the medical community is rapidly losing its validity as this author has uncovered a growing number of pro-NFT studies, published in very scholarly and suitably professional journals. While some of the more sensationalized and polemical titles book-length treatments remain suspect as titles for permanent collections serving the medical and mental health professions, newer monographs discussing NFT have, for the most part, migrated to better presses. The very newest is Biofeedback for the Brain: How Neurotherapy Effectively Treats Depression, ADHD, Autism & More. It’s a 2008 title from Rutgers University Press, and its author, Dr. Paul G. Swingle, Ph.D. Fellow & Past President of the Canadian Psychological Association, has held a number of distinguished positions at both Canadian and US Universities, medical schools, and their affiliated hospitals (include Harvard Medical School and its premier hospital for mental disorders, Maclean).
For a detailed review of over 150 pro-and-con studies on neurofeedback in the context of ADHD, see:
Stankus, T. 2008. Can the brain be trained? Comparing the literature on the use of EEG Biofeedback/Neurofeedback as an alternative or complementary therapy for Attention Deficit Hyperactivity Disorder (ADHD). Behavioral and Social Sciences Librarian 26 (4): 20-56.
Tony Stankus [email protected] Life Sciences Librarian & Professor
University of Arkansas Libraries MULN 223 E
365 North McIlroy Avenue
Fayetteville, AR 72701-4002
Voice: 479-409-0021
Fax: 479-575-4592
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